Rationale, aims and objectives
Psychomotor disturbances have been regarded as cardinal symptoms of depression for centuries, and their objective assessment may have predictive value with respect to the severity of clinical depression, treatment outcome, and prognosis of the depressive disorder. In clinical practice, psychomotor disturbances are evaluated and measured subjectively—through clinical observation and/or by means of rating scales. Our aim is to introduce a novel objective approach for recording and measuring psychomotor activity and reactivity in patients with clinical depression.
Method
Psychomotor indicators of activity and reactivity were objectively recorded and measured using computerized ultrasonographic cranio‐corpo‐graphy.
Results and discussion
Objective and quantitative assessment of psychomotor symptoms may have pathophysiological significance as psychomotor disturbances go along with affective dysregulation. It is presumed that common neurotransmitter pathology in the brain structures causes simultaneously psychomotor and affective dysregulation that underlies the pathophysiology of the depressive disorder. Also, psychomotor retardation is thought to be a cardinal depressive symptom in endogenous depressions—unipolar and bipolar. On the other hand, psychomotor agitation may be considered as latent bipolarity, although the presence of manic symptoms within a depressive state and the role of psychomotor agitation in depressive patients are still disputable.
Conclusion
Integration between different methods is needed to improve the understanding of psychopathology and neurobiology of a disputable diagnosis such as clinical depression. We introduce in the field of psychiatry an objective and quantitative approach, which could permit psychomotor discrimination not only between depressive patients and healthy controls but also between subgroups of depressive patients.
Psychiatry is the only medical specialty that lacks clinically applicable biomarkers for objective evaluation of the existing pathology at a single-patient level. On the basis of an original translational equilibriometric method for evaluation of movement patterns, we have introduced in the everyday clinical practice of psychiatry an easy-to-perform computerized objective quantification of the individual locomotor behaviour during execution of the Unterberger stepping test. For the last 20 years, we have gradually collected a large database of more than 1000 schizophrenic patients, their relatives, and matched psychiatric, neurological, and healthy controls via cross-sectional and longitudinal investigations. Comparative analyses revealed transdiagnostic locomotor similarities among schizophrenic patients, high-risk schizotaxic individuals, and neurological patients with multiple sclerosis and cerebellar ataxia, thus suggesting common underlying brain mechanisms. In parallel, intradiagnostic dissimilarities were revealed, which allow to separate out subclinical locomotor subgroups within the diagnostic categories. Prototypical qualitative (dysmetric and ataxic) locomotor abnormalities in schizophrenic patients were differentiated from 2 atypical quantitative ones, manifested as either hypolocomotion or hyperlocomotion. Theoretical analyses suggested that these 3 subtypes of locomotor abnormalities could be conceived as objectively measurable biomarkers of 3 schizophrenic subgroups with dissimilar brain mechanisms, which require different treatment strategies. Analogies with the prominent role of locomotor measures in some well-known animal models of mental disorders advocate for a promising objective translational research in the so far over-subjective field of psychiatry. Distinctions among prototypical, atypical, and diagnostic biomarkers, as well as between neuromotor and psychomotor locomotor abnormalities, are discussed. Conclusions are drawn about the translational and clinical implications of the new approach and its future perspectives.
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